Individual provider Active NPI

Audrey A Lemasters, LCSW

  • Clinical Social Worker
  • Peoria, IL
National Provider Identifier
1811058753
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149009095 Issued in IL
Practice address
900 Main St
Suite 580
Peoria, IL 61602-1005
Phone
(309) 637-4266
Fax
(309) 637-9836
NPI assigned
Dec 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149009095 IL Primary

Addresses

Primary practice location

900 Main St
Suite 580
Peoria, IL 61602-1005

Mailing address

719 W Lake Ave
Peoria, IL 61614-5941
Phone (309) 408-1493

Other practice location 1

719 W Lake Ave
Peoria, IL 61614-5941
Phone (309) 408-1493

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100312001016 IL Practitioner - Clinical Social Worker 9234264474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edge Counseling and Wellness LLCGroup PAC ID 1951659465, 8 clinicians

Practice addresses (Care Compare)

5101 N Executive Dr
Peoria, IL 61614-4868
Phone (309) 408-1493

719 W Lake Ave
Peoria, IL 61614-5941

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Edge Counseling and Wellness LLC Clinical CurrentSince Jun 8, 2018 Accepting new patients

Locations

719 W Lake Ave
Peoria, IL 61614
Phone (309) 408-1493

5101 N Executive Dr
Peoria, IL 61614
Phone (309) 408-1493

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1811058753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145941",
            "telephone_number": "309-408-1493",
            "fax_number": "309-691-9357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MAIN ST",
            "address_2": "SUITE 580",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021005",
            "telephone_number": "309-637-4266",
            "fax_number": "309-637-9836"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "719 W Lake Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616145941",
            "country_code": "US",
            "telephone_number": "309-408-1493",
            "fax_number": "309-691-9357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEMASTERS",
        "first_name": "AUDREY",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149009095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.